The outpatient acquisition wave is no longer a trend to watch. It is the defining structural force reshaping how surgical care, physician services, and urgent care are owned, staffed, and how companies compete for them.
More than 40 physician practice transactions closed in the first half of 2026 alone. Seventy-one new ASCs opened across the country in 2025. And the $3.9 billion Ascension-AmSurg deal that closed in June moved 300 ASCs from one owner to another in the span of 12 months.
Here is what is driving it and what it means for the ASC operators in the middle of it.
1. The buyer universe has never been more diverse
Health systems, private equity, payers and physician-owned platforms are all acquiring outpatient assets simultaneously, and for different reasons. The physician medical group subsector captured a record 46% share of first-quarter 2026 healthcare deal volume, generating 2.9 times more transactions than the next largest subsector, according to PwC’s Health Services Midyear Outlook.
Payers are building primary care platforms to control patient access. Health systems are shedding hospitals and buying ambulatory infrastructure. PE firms are adding to existing platforms. The same clinic or practice can attract multiple buyer types at once and each values it for a different reason. According to an urgent care M&A report from Auxo Capital Advisors, a health system may pay for downstream referrals and market coverage that a financial buyer cannot credit.
2. Independent practices are the primary acquisition target
Between 2019 and 2023, the share of physician practices owned by hospitals, health systems, or other corporate entities jumped from 39% to 59%, while physician employment by these entities rose from 62% to 78%, according to a December 2025 report from the Progressive Policy Institute. In 2024, 42.2% of physicians worked in private practice, down from 60.1% in 2012, according to the AMA’s Physician Practice Benchmark Report. The independent practice is not disappearing, but the pool available for acquisition is shrinking, and the pressure on those that remain is intensifying.
3. Payers are the new acquirers to watch
Humana’s CenterWell Senior Primary Care added more than 100,000 patients in 2025, more than 25% year-over-year growth, including approximately 32,000 through the acquisition of The Villages Health in Florida. Insurers like Humana are building or buying primary care platforms to control the front door of care for Medicare Advantage members, reduce downstream utilization costs and capture margin across the care continuum.
4. Health systems are pivoting from hospitals to outpatient at scale
In a 2025 VMG Health survey of health system executives, outpatient surgery ranked as the top service line for joint venture partnerships, with more than 60% of respondents naming ASCs as a primary growth interest.
Ascension reduced its hospital portfolio from roughly 140 facilities to 91 and then spent $3.9 billion on AmSurg. Trinity Health New York is shifting capital away from hospital-heavy investments toward primary care centers, orthopedic centers and ASCs. CommonSpirit added 90 ambulatory sites over two fiscal years. The pattern is consistent: sell or close hospitals, buy or build outpatient facilities.
5. ASC development is running parallel to acquisition
Seventy-one new ASCs opened across the U.S. in 2025, with North Carolina and California leading at eight new centers each, and Texas following with four. De novo development is accelerating alongside acquisition because, as Southlake, Texas-based Solara Surgical Partners Chief Development Officer Steve Hockert told Becker’s, the inventory of mature independently owned ASCs available for purchase is thinning.
6. Urgent care is being absorbed into the broader outpatient ecosystem
Orthopedic urgent care and walk-in clinic models are emerging as a natural upstream partner for ASCs, according to Alejandro Badia, MD, founder and CMO of Miami-based Badia Hand to Shoulder Center.
“Collaboration between a convenient walk-in facility, for example, an orthopedic urgent care center and an ASC, will drive up musculoskeletal surgical volume, while lowering overall healthcare system costs,” Dr. Badia told Becker’s.
Urgent care acquisition activity mirrors the ASC and physician practice consolidation wave, according to the Auxo report, as strategic operators, PE-backed platforms, health systems, payer-affiliated buyers and physician-led groups compete for the same assets.
7. Orthopedics, cardiology and GI are leading specialty consolidation
Cardiology, gastroenterology and orthopedics are seeing the fiercest buyer competition in physician practice M&A, with ophthalmology close behind, according to Focus Investment Banking’s 2026 report. In the first half of 2026 alone, RadNet acquired two radiology groups, Ascend Vision Partners entered Oklahoma with three ophthalmology acquisitions, Vision Innovation Partners added two practices and Atria Heart acquired Cardiovascular Consultants in Phoenix.
8. Three-way joint ventures are becoming the preferred structure for independent physicians
“Independent physicians are really in a squeeze right now,” Mark Langston, chief development officer at Compass Surgical Partners, told Becker’s. “Small practices struggle in risk-based models, lack payer leverage, and often can’t afford needed infrastructure.”
Three-way joint ventures between physician groups, health systems and management companies are emerging as the preferred alternative to outright acquisition for practices that want capital and infrastructure without surrendering governance. The model pools resources while maintaining physician equity, which is a structure that is becoming central to health system ASC strategy as well.
9. Antitrust scrutiny is rising alongside deal volume
The FTC’s consent order requiring Ascension to divest seven ASCs before closing the AmSurg deal was the first time regulators applied that level of scrutiny to an ASC-specific transaction. The agency’s local-market framework, which defines competition as metro-area and service-line specific rather than national, signals that future megadeals will face geographic overlap analysis earlier and more rigorously.
Private equity-backed roll-up strategies have helped build some of the largest ASC platforms through a series of smaller acquisitions that may not individually trigger federal reporting requirements. By the time a larger acquisition takes place, policymakers may be reviewing a transaction in a market that has already shifted substantially, according to the Private Equity Stakeholder Project.
10. The window for independent operators is narrowing, not closing
Fifty-nine percent of independent ASCs said they would consider a strategic partnership rather than a full transaction, and 71% of those open to partnerships said they would consider partnering with a health system, according to a VMG Health survey. The outpatient acquisition wave is creating strategic value for well-run independent operators as buyers need credible alternatives in local markets, and the FTC’s enforcement posture is making geographic scarcity an asset.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.